Infantile outcome at 3 years of age among monochorionic twins with Type-II or -III selective fetal growth restriction with isolated oligohydramnios who underwent fetoscopic laser photocoagulation

R Yamamoto; K Ozawa; S Wada; H Sago; S Nagasaki; M Takano; M Nakata; M Nozaki; K Ishii; Collaborators

doi:10.1002/uog.27551

Infantile outcome at 3 years of age among monochorionic twins with Type-II or -III selective fetal growth restriction with isolated oligohydramnios who underwent fetoscopic laser photocoagulation

Ultrasound Obstet Gynecol. 2023 Nov 29. doi: 10.1002/uog.27551. Online ahead of print.

Authors

R Yamamoto¹, K Ozawa², S Wada², H Sago², S Nagasaki³, M Takano³, M Nakata³, M Nozaki⁴, K Ishii¹; Collaborators

Collaborators

Collaborators:
Jin Muromoto, Rika Sugibayashi, Shusaku Hayashi, Yuji Ito

Affiliations

¹ Department of Maternal Fetal Medicine, Osaka Women's and Children's Hospital, Izumi, Japan.
² National Center for Child Health and Development, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, Tokyo, Japan.
³ Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.
⁴ Department of Neonatology, Osaka Women's and Children's Hospital, Izumi, Japan.

PMID: 38031151
DOI: 10.1002/uog.27551

Abstract

Objective: This study aimed to examine infantile outcomes at 3 years of age with selective fetal growth restriction (sFGR) Types II and III with isolated oligohydramnios who underwent fetoscopic laser photocoagulation (FLP).

Methods: This multicenter prospective cohort study included monochorionic diamniotic twins who underwent FLP for sFGR between 16 and 25 weeks of gestation. The indication for performing FLP was in cases of sFGR Type II or III with oligohydramnios, where the maximal vertical pocket was ≤2 cm among twins with FGR. This was done in the absence of a typical twin-twin transfusion syndrome diagnosis. The primary outcome was the intact survival (IS) rate of infants at the corrected age of 40 weeks and 3 years. IS at the corrected age of 40 weeks was defined as survival without grade III or IV intraventricular hemorrhage or cystic periventricular leukomalacia, and IS at 3 years of age was defined as survival without neurodevelopmental morbidity, including cerebral palsy, neurodevelopmental impairment with a total developmental quotient of ≤70, bilateral deafness, or bilateral blindness.

Results: Among 45 patients with sFGR, 30 (66.7%) were classified as having Type II and 15 (33.3%) as Type III sFGR. The prevalence of IS at the corrected age of 40 weeks was 51.1% (n=23) in FGR twins and 95.5% (n=42) in larger twins. The prevalence of IS at 3 years of age was 46.7% (n=21) in FGR twins and 86.4% (n=38) in larger twins. Among the 24 FGR twins who were not diagnosed with IS at 3 years of age, 91.7% (22 of 24 cases) suffered fetal or infantile demise other than miscarriage and neurodevelopmental impairment. All larger twins who were not diagnosed with IS at 3 years of age (n=6, 13.6%) had neurological morbidity, in addition to one case of miscarriage.

Conclusions: FGR twins and larger twins, when subjected to FLP due to sFGR coupled with umbilical artery Doppler abnormalities and isolated oligohydramnios, exhibit low rates of neurological morbidity and low mortality, respectively. Therefore, FLP for Type II or III sFGR with oligohydramnios may be a feasible and preferable management option. This article is protected by copyright. All rights reserved.

Keywords: fetal growth restriction; fetoscopic surgery; neurological development; twin pregnancy.